Confidentiality in Nursing Practice - 826 Words

The Importance of Confidentiality in Nursing Practice This essay will discuss why confidentiality is important within nursing practice and the reasons why a registered nurse and student nurse are accountable and to whom they are accountable to in relation to patient care. It will further discuss patient’s rights in relation to law. Definition of Confidentiality, Bailliere’s Dictionary (2005) â€Å"Spoken, written or given in confidence† With this in mind the Nursing Midwifery Council states: â€Å"As a registered Nurse, Midwife or Health†¦show more content†¦Consent can be quite tricky, a legal minefield for healthcare teams, this is due to the patients who will give or refuse to give private information about themselves who is legally competent butShow MoreRelatedThe Role Of The Nmc And The Code Of Practice919 Words   |  4 Pagesthe role Nursing and Midwifery Council plays in safeguarding the public and maintaining standard care within the UK. 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The Problem Of Induction And Its Metaphysical Implications

The problem of induction and its metaphysical implications. The pursuit of knowledge and the desire to understand our world in terms of what is and what it is like has been the endeavor of mankind for centuries. One of the main methods used in order understand the reality presented to us is inductive inference. While humanity has no doubt advanced by employing inductive inference, the problem of induction, recognized by David Hume (1711-1776) forces us to question if induction is a justifiable method and in turn what that means concerning the knowledge acquired by its application. The result of the problem of induction is that we cannot rely on past experience to help us understand the past, our current situation or make future†¦show more content†¦Relations of ideas are a priori and are logically true statements, they are epistemologically prior to experience and the denial of such a proposition implies a contradiction. For example, a square has four equal sides and imagini ng a square with five sides, or unequal sides leads to contradiction as the definition of a square is, ‘a shape with four equal sides’ and as a result nothing will be a square unless it has four equal sides. Conversely, matters of fact are a posteriori and therefore grounded in experience, this means that they can be denied without any contradiction as an alternate statement can be just as plausible. As an example, if the statement is made that, ‘it is raining outside’ it is no less plausible to think that it is not raining outside and so until it has been experienced one cannot say that either of these situations is more likely than the other. In the world we live in and especially in science, it is not always possible to experience every instance of a phenomena in question and that is why we look to other methods to advance our knowledge. We are only able to increase our knowledge by moving from the particular to the general, which is how the process of i nduction works. However, the question that arises is, ‘when is it justifiable to make a general claim

Discussion on MERS-Free-Samples for Students-Myassignementhelp

Question: Critical review of the literature on one Emerging or Re-Emerging Communicable Disease Threat. Answer: Introduction Middle East Respiratory Syndrome (MERS) is a respiratory syndrome that can be traced back to Saudi Arabia in 2012. It was initially restricted to persons who were traveling within the Middle East and/or their contacts, but later had a spill-over effect into other countries as demonstrated by outbreaks in countries out of the Middle East block such as the Republic of Korea (RoK), Austria, the Philippines, Thailand, France, Tunisia, Germany, Malaysia, Greece and the United Kingdom (World Health Organization (WHO), 2017; NSW Government, 2017). MERS is caused by Middle Eastern respiratory syndrome coronavirus (MERS-CoV). MERS is not a national notifiable in Australia, but it is at least classified as a notifiable condition in some parts of Australia, precisely South and Western Australia (Government of South Australia - SA Health, n.d.) and the US (Centers for Disease Control and Prevention (CDC), 2015). This paper is a discussion on MERS with focus on the role of agent, host and environmental factors in the development and spread of the condition and the corresponding potential policy responses to the same. This is achieved through discussions on three main sections. The first section discusses the epidemiology, transmission routes, risk factors and clinical features, while the second part is a discussion on the interaction between the causative agent, host and environmental factors in the production of the illness in individuals, and the last part discusses various responses towards the control of the spread of the virus. Discussion Epidemiology, Transmission Routes, Risk Factors and Clinical Features The MERS coronavirus belongs to the large and diverse family of coronaviruses which are known to cause ill health to both humans and animals. Four strains of coronaviruses that affect humans {human coronaviruses (hCoV)} are known to cause respiratory infections in human, with severity ranging from mild to moderate. These hCoVs include the alpha-coronaviruses hCoV-NL63 and hCoV-229E and betacoronaviruses hCoV-HKU and hCoV-OC43 (The Department of Health, 2014). In the class of beta-coronaviruses also lies the viruses causing MERS-CoV and severe acute respiratory syndrome coronavirus (SARS-CoV). However, according to The Australian Department of Health, these two viruses are genetically distinct from each other (The Department of Health, 2014). The MERS coronavirus was only identified in 2012 as a new variant of the coronavirus family that could lead to a rapid onset of severe respiratory illness in humans (Zaki, van Boheemen, Bestebroer, Osterhaus, Fouchier, 2012). Most of MERS cases have been found to develop in persons presenting with other underlying conditions which predispose them to respiratory infections. While MERS-CoV is distinct from the SARS-CoV in humans, the MERS-CoV has some similarity to coronaviruses found in bats (The Department of Health, 2014). Up to date, all cases of MERS in humans have been in persons who have been residents in or travellers to the countries in the Middle East or have had a close contact with persons presenting with the infection in the same region. The disease has been predominantly reported in in travellers or residents in the United Arab Emirates (UAE), Jordan, Qatar and the Kingdom of Saudi Arabia (Who Mers-Cov Research Group., 2013). But as demonstrated in later years, the infection is not just restricted to the Middle East as evidenced by the reported cases in countries, not in the Middle East. This includes countries in Europe such as Italy, Germany, the United Kingdom, France, Tunisia, Malaysia, South Korea, the Philippines, Thailand and Greece (NSW Government, 2017). South Korea reported the largest outbreak in 2015, which was a multi-centre hospital outbreak which was traced to a traveller from the Middle East (WHO, 2015; CDC, 2015). Notably, Australia has so far reported zero MERS-CoV cases. ( NSW Government, 2017). A MERS situation update by WHO for the months of January and February 2017 states that as of the beginning of March 2017, a total of 1,916 laboratory confirmed cases of MERS have been reported to WHO and a total of 702 persons have died, translating to a case-fatality rate of 36.6% (WHO, 2017). According to the same update, a total of 27 countries worldwide have reported MERS cases. Transmission routes The epidemiologic aspects of the MERS-CoV have not been adequately defined, but the most recognized means of transmission is the human-to-human transmission of the virus, in healthcare settings. However, just like other coronaviruses, the spread of the virus is thought to occur through contact with an infected individuals secretions. The exposure in healthcare facilities could be justified by the 2015 outbreak in South Korea and Saudi Arabia, whose point of introduction is always a single introduction of MERS, probably zoonotic (Al-Abdallat, et al., 2014). According to the WHO, MERS-CoV is a zoonotic virus which enters the sphere of humans through contact with infected dromedary camels in the Middle East (WHO, 2016). The restriction that it is dromedary camels in the Arabian Peninsula can be supported by negative findings of the virus in tested camels from other parts of the world (Chan, et al., 2015). Studies have demonstrated strong indicators of both direct and indirect exposure to camels to causing the infections. This hypothesis is supported by at least one group in which the camels also tested seropositive (WHO, 2017). Outstandingly, a review of literature also indicates cases where the infections resulted even in the absence of a history of prior exposure to other animals. This perspective rather suggests the likelihood of the virus being introduced through multiple channels as opposed to a single zoonotic case. The primary hypothesis in the transmission and resulting outbreaks of MERS has been a hypothesised link to some animals serving as either the reservoir or intermediate host(s), with dromedary camels as the primary suspects. They are known to produce a significant amount of MERS-CoV RNA in their lungs and the urinary tract (Khalafalla, et al., 2015). The droplet transmission route is claimed to play a significant role in the transmission of the virus. The exact source from which people acquire the virus from camels has not been clearly defined but it is postulated that there is an intricate interplay of both animal and human behaviours as demonstrated in the figure below. Source: (Mackay Arden, 2015) Figure 1: Speculated transmission routes of MERS-CoV and how humans and camels contribute to epidemics. Human-to-human transmission of the virus has also been observed especially in healthcare settings, among family workers, and among co-workers. The usually suspected transmission mechanisms in human-to-human transmission have been suspected to be either respiratory (sneezing, coughing) or direct physical contact with the affected individual or contamination of the environment by the infected individuals, but this is yet to be fully demonstrated. The only definitive comment made by the WHO is that the virus is not easily transmitted from an individual to another unless there is close contact between the two, as demonstrated in the provision of unprotected care to an infected patient (WHO, 2017). Cases of human-to-human transmission have only been documented in the health care environment and nowhere else. Notably, the origins of MERS-CoV virus are yet to be fully understood, but analysis of the virus genomes have demonstrated that the virus could have originated in bats and was transmitted to dromedary camels during early ages. Risk factors The distribution of the disease among the already reported cases is demonstrated to be skewed heavily to middle-aged persons and the elderly. The risk is heightened in persons who are elderly, are immunocompromised, or present with other comorbidities (WHO, 2017). For MERS associated with the health care environment, the risk for infection among healthcare workers is magnified among those who have close contact with patients infected with the virus, especially radiology technicians and nurses (Alraddadi, et al., 2016). In addition, according to the same authors, health care workers with a history of smoking had 3 times increased risk for the infection compared to non-smokers. This association further arouses the curiosity of the role that smoking plays in the risk profile, unluckily, there is no literature addressing the same. This requires further research. Males aged above 60 years are also claimed to be at increased risk of contracting the virus. The risk is further heightened if they suffer from underlying conditions such as renal failure, hypertension, and diabetes (WHO, 2017). A twist to this association could rather suggest that instead of a sex-specific difference in biologic susceptibility, males have exhibit social and behavioural factors which increase their exposure to the virus compared to females. This can be supported by an observation by Mackay and Arden, (2015) in which males infected by MERS-CoV present with a more severe disease compared to females of the same class. Clinical picture The mean incubation period for MERS-CoV has been determined to be 5 to 6 days, ranging from 2 to 16 days, with 13-14 days between when one person develops the diseases and spreads it to another (Assiri, et al., 2013; Memish, Zumla, Al-Hakeem, Al-Rabeeah, Stephens, 2013). For cases with progressive illness, the median death is 11-13 days (Assiri, et al., 2013; Ki, 2015). Early symptoms of the illness include fever, myalgia, chills and gastrointestinal symptoms, which subsequently decline, only be substituted with more severe systemic and respiratory syndrome, severe pneumonia with acute respiratory distress syndrome and multi-organ failure (Kraaij-Dirkzwager, et al., 2014; Mailles, et al., 2013). The Interaction Between The MERS-CoV, Host and Environmental Factors to Produce MERS Majority of camels in the Arabian Peninsula are dromedary camels and their contact with humans ranges between little to close. This contact serves as the gateway to the transmission and the corresponding outbreaks; hence it is significant to illustrate the interplay of the agent, the reservoir and the environmental factors that predispose the host to the virus and consequential development of the syndrome. The human-camel contact is commonplace in the Arabian Peninsula and may result from various ways (as illustrated in the figure above). Most of the countries in the Middle East (with special reference to Saudi Arabia due the fact that it has so far recorded the highest number of cases), has several large well-attended festivals, parades, sales and races which feature dromedary camels and also, these camels are bred and reared close to populated areas (Al-Mukhtar Estimo, 2014; Hemida, et al., 2015)127-128. In addition, inhabitants of these countries have the tendency to consume milk and meat from camels after the Hajj pilgrimage (Mackay Arden, 2015). Notably, however, reports of infections of MERS-CoV are much lower compared to the frequent habits of preparing, drinking, eating products from dromedary camels. It is also established that some tribes in Saudi Arabia consume fresh unpasteurised milk from dromedary camels, alongside their urine which is claimed to be having some health b enefits. It is however interesting to note that butchers make up a larger proportion of the local occupations, and neither them nor any of the associated risk groups have ever been identified among MERS cases (Mackay Arden, 2015). A logical explanation to explain the same is that there is a heightened likelihood to be a reporting issue and not just an unexplainable absence of the illness. This association can be corroborated by evidence from a 2015 case-control study that concluded that the onset of MERS is as a result of direct contact with dromedary camels and not the ingestion of products from these animals (Alraddadi, et al., 2014). Some researchers hold a different hypothesis that there is the likelihood of humans infecting dromedary camels, contrary to the already established hypothesis. This divergent proposition has been instigated by laboratory finding in which whenever cases of MERS have been reported, the camel population is also found to have nasal colonisation of the v irus alike. This hypothesis is however yet to be studied and proven. Camels often calve during the winter months that run between late October and late February and this season may be characterised by an increased risk of spill-over of the virus to humans because new infections are often likely to occur within the camel populations (Hemida, et al., 2015). The role played by maternal camel antibody in delaying infection in the calves is yet to be established (Memish, et al., 2013; Hemida, et al., 2015). Young camels have been found to host active infection more often compared to their parents, and as a result of the inclination to choose camels aged 5 years or older for sacrificial slaughter, and this is accompanied with an insignificant risk of exposure to the virus. This conclusion draws reference back to the fact that slaughterhouse workers stand out as a high-risk occupational group. The survivability of MERS-CoV in the environment is also important towards understanding the association between the various parameters leading to the development of the illness. Laboratory experiments have demonstrated that adding the virus to milk from either a camel, goat or cow, and storing it at low temperatures (4 degrees Celsius), the virus could still be recovered at least seventy-two hours later, and if stored at 22 degrees Celsius (almost room temperature), the virus could still survive up to 48 hours (van Doremalen, Bushmaker, Munster, 2013). On the survivability of the virus in the environment in the absence of a milk medium, a study by van Doremalen, Bushmaker, and Munster, (2013) was able to demonstrate that even at high ambient temperatures (about 30 degrees Celsius) and low relative humidity (30%), the virus still remains viable for up to 24 hours. This demonstrates quite a significant survivability rate compared to other well-known and efficiently transmitted respiratory virus such as influenza A virus which cannot be recovered even after four hours under the same conditions to those survived by MERS-CoV (van Doremalen, Bushmaker, Munster, 2013). However, the survival of MERS-CoV is still said to be inferior compared to that of SARS-CoV (Chan, et al., 2011). MERS outbreaks have been so far experienced in health care settings as opposed to community settings. It is therefore hypothesized that the hospital environmental facilitates environments that promote super-spreading of MERS-CoV. The above-demonstrated survivab ility characterised therefore plays a significant role in the development of these outbreaks. For purposes of understanding how they contribute to this, it is an established fact that pathogenic bacteria can remain viable and airborne for three-quarters of an hour in a coughed aerosol and can spread for four metres (Mackay Arden, 2015). The ability of MERS-CoV to remain viable for extended times gives it the capacity of thoroughly infecting surfaces of rooms occupied by either infected or symptomatic patients (Knibbs, et al., 2014). It is however unknown whether the virus can remain truly airborne. These findings help paint a clear picture of the possibilities of aerosols to transmit the virus in various settings such as hospital waiting rooms, treatment rooms, private patient rooms, emergency departments and open intensive care facilities. It is thus of significance to consider the variable or air exchange, circulation and filtration as variable in measuring and reducing the risk of MERS-CoV spread, and the use of negative pressure rooms in the containment of known cases. Human-to-human transmission is attributed to droplet spread as demonstrated in both outbreaks in Saudi Arabia and South Korea (Assiri, et al., 2013; Assiri A. , et al., 2013; Al-Tawfiq Memish, 2014; Zumla Memish, 2014). As a result, environmental control in terms of risk measurement and reduction efforts directed at curbing the spread should be targeted at aerosols-generating events that involve camels (urination, defecation, and preparation and consumption of camel products), and the formulation of personal protective equipment worn by healthcare workers working with infectious cases. Policy Responses To MERS-CoV The response to MERS can be categorized to either individual countries or as a cumulative response by the World Health Organisation. Notably, however, no specific policies have been designed to control the virus, but rather various guidelines are available for the control of the same. For instance, the Saudi Arabian Ministry of health has responded with both outbreak control policies touching on notification of suspected cases, risk assessment, investigation procedures and treatment protocols. WHO has likewise taken various steps and also projected steps to be undertaken later on. WHO works with various countries, and has notably worked with CDC to develop policies aimed at improving the efficiency of surveillance (Banerjee, Rawat, Subudhi, 2015), and the Saudi Arabian Ministry of Health (MoH) to develop specific guideline for the control and prevention of infections by the virus for both health care workers, patients and their family members contained under the Scientific Advisory Boards Infection Prevention and Control Guidelines for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection (Saudi Arabia Ministry of Health, 2014; Scientific Advisory Board, 2015). Neither CDC nor Saudi Arabia MoH has prescribed specific guidelines for the control of the agent, but have rather made recommendations for quarantine measures for infected individuals and have also prescribed guidelines to be followed before the infected person resumes regular activities following recovery. Both the CDC, Saudi Arabian MoH and various agencies from most countries (Australia included) have also prescribed guidelines for airport staff on the management of suspected MERS cases, and likewise developed advisories and precautionary statements for travellers into and out of the countries. The WHO Director-General convened the International Health Regulations (IHR) Emergency Committee on MERS which is chaired by Australias Chief Medical Officer (The Department of Health, 2016). In the case of Australia, the countrys Communicable Diseases Network Australia has also developed a national guideline for the public health management of MERS, and these guidelines have also been endorsed by the Australian Health Protection Principal Committee (AHPPC). In addition, as from 2015, information is provided on the disease to both the public, clinicians, laboratory and public health personnel and general practitioners. State and territorial AHPPC and its standing committees work in tandem with the Australian department with regard to this. Among these recommendations, it is stipulated by the Public Health Laboratory Network that the ideal diagnosis of the infections should be done using PCR-based tests. In addition, the government through the Department of Foreign Affairs and Trade ( DFAT) has issued a Smartraveller bulletin on MERS alongside country-specific advice for travelling to the affected countries. As the coordinating body, the WHO strives for the development and application of universal standard infection control precautions and transmission-based precautions when dealing with MERS (The Department of Health, 2016). Conclusion MERS-CoV stands as one of the emerging infectious agents responsible for a significant amount of respiratory illness across three continents. MERS was originally restricted to countries in the Arabian Peninsula but as a result of human dynamics, it has successfully caused outbreaks outside of the Middle East with the most notable one being a healthcare-associated in South Korea in which 186 persons were infected and a total of 36 died. The main transmission routes for MERS-CoV are camel-to-human and human-to-human. Dromedary camels remain as the primary reservoir of the virus which is claimed to have been sourced from paths. Several epidemiologic aspects of MERS are however yet to be known. Hospital environments are characterised to be bearing ideal conditions for the spread of the virus, hence liable to the health care outbreaks so far. Regardless of the infection having been reported across 27 countries, neither individual countries nor the WHO have developed any specific policies aimed at controlling the virus, but rather various guidelines have been provided. References Al-Abdallat, M., Payne, D., Alqasrawi, S., B, R., Tohme, R., Abedi, G., . . . Haddadin, A. (2014). Hospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description. Clin Infect Dis. , 1225-33. Al-Mukhtar, R., Estimo, R. (2014). Link between MERS virus and camels worries breeders. Alraddadi, B. M., Al-Salmi, H. S., Jacobs-Slifka, K., Slayton, R. B., Estivariz, C. F., Geller, A. I., . . . Haynes, L. (2016). Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Healthcare Personnel. Emerg Infect Dis, 1915-1920. Alraddadi, B., Watson, J., Almarashi, G., Turkistani, A., Sadran, M., Housa, A. (2014). Risk Factors for Primary Middle East Respiratory Syndrome Coronavirus Illness in Humans, Saudi Arabia. Emerg Infect Dis. Al-Tawfiq, J., Memish, Z. (2014). Middle East respiratory syndrome coronavirus: transmission and phylogenetic evolution. Trends Microbiol., 573-9. Assiri, A., Al-Tawfiq, J., Al-Rabeeah, A., Al-Rabiah, F., Al-Hajjar, S., Al-Barrak, A., . . . M. Z. (2013). Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis., 752-61. Assiri, A., McGeer, A., Perl, T. M., Price, C. S., Rabeeah, A. A., Cummings, D. A., . . . Mad, H. (2013). Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus. NEJM, 407-416. Assiri, A., McGeer, A., Perl, T., Price, C., Al Rabeeah, A., Cummings, D. (2013). Hospital outbreak of Middle East respiratory syndrome coronavirus. 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Chan, S., Damdinjav, B., Perera, R., Chu, D., Khishgee, B., Enkhbold, B., . . . Peiris, M. (2015). Absence of MERS-Coronavirus in Bactrian Camels, Southern Mongolia, November 2014. Emerg Infect Dis., 1269-71. Government of South Australia - SA Health. (n.d.). Middle East respiratory syndrome (MERS) - including symptoms, treatment and prevention. Retrieved from SA Health: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/infectious+diseases/middle+east+respiratory+syndrome Hemida, M., Elmoslemany, A., Al-Hizab, F., Alnaeem, A., Almathen, F., Faye, B. (2015). Dromedary Camels and the Transmission of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Transbound Emerg Dis, [Epub ahead of print]. Khalafalla, A., Lu, X., Al-Mubarak, A., Dalab, A., Al-Busadah, K., Erdman, D. (2015). MERS-CoV in Upper Respiratory Tract and Lungs of Dromedary Camels, Saudi Arabia, 2013-2014. Emerg Infect Dis., 53-8. 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Memish, Z., Cotten, M., Meyer, B., Watson, S., Alsahafi, A., Al Rabeeh, A. (2013). Human Infection with MERS Coronavirus after Exposure to Infected Camels, Saudi Arabia. Emerg Inf Dis, 1012-5. Memish, Z., Zumla, A., Al-Hakeem, R., Al-Rabeeah, A., Stephens, G. (2013). Family cluster of Middle East respiratory syndrome coronavirus infections. N Engl J Med., 2487-94. NSW Government. (2017, July 28). MERS coronavirus (MERS-CoV) fact sheet. Retrieved from NSW Government: https://www.health.nsw.gov.au/Infectious/factsheets/Pages/MERS-coronavirus.aspx Saudi Arabia Ministry of Health. (2014). Update in Statistics: Ministry of Health Institutes New Standards for Reporting of MERS-CoV. Retrieved from Ministry of Health Command Control Center: https://www.moh.gov.sa/en/CCC/News/Pages/News-2014-06-03-001.aspx Scientific Advisory Board. (2015). Infection Prevention and Control Guidelines for Middle East. Riyadh: Ministry of Health Kingdom of Saudi Arabia. The Department of Health. (2014, November 28). Middle East Respiratory Syndrome coronavirus (MERS-CoV) Laboratory Case Definition (LCD). Retrieved from Australian Government Department of Health: https://acpc.gov.au/internet/main/publishing.nsf/Content/cda-phlncd-MERS-CoV.htm The Department of Health. (2016). Middle East respiratory syndrome (MERS): Situation update 10 March 2016. Sydney: Australian Government Department of Health. van Doremalen, N., Bushmaker, T., Munster, V. (2013). Stability of Middle East respiratory syndrome coronavirus (MERS-CoV) under different environmental conditions. Euro Surveill. WHO. (2015, June 19). Middle East respiratory syndrome coronavirus (MERS-CoV): Summaryand Risk Assessment of Current Situation in the Republic of Korea and China as of 19 June 2015. Retrieved from World Health Organization: https://www.who.int/emergencies/mers-cov/mers-cov-republic-of-korea-and-china-risk-assessment-19-june-2015.pdf WHO. (2016, December 5). WHO MERS-CoV Global Summary and risk assessment. Retrieved from World Health Organization: https://www.who.int/emergencies/mers-cov/mers-summary-2016.pdf WHO. (2017, March). MERS situation update, JanuaryFebruary 2017. Retrieved from World Health Organization: https://www.emro.who.int/surveillance-forecasting-response/surveillance-news/mers-situation-update-januaryfebruary-2017.html WHO. (2017, May). Middle East respiratory syndrome coronavirus (MERS-CoV). Retrieved from WHO: https://www.who.int/mediacentre/factsheets/mers-cov/en/ WHO. (2017). WHO MERS-CoV Global Summary and Assessment of Risk. Geneva: WHO. Who Mers-Cov Research Group. (2013). State of Knowledge and Data Gaps of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Humans. PLoS Curr. World Health Organization (WHO). (2017). Coronavirus infections; Disease Outbreak News. Retrieved from WHO Emergencies preparedness, response: https://www.who.int/csr/don/archive/disease/coronavirus_infections/en/ Zaki, A., van Boheemen, S., Bestebroer, T., Osterhaus, A., Fouchier, R. (2012). Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med, 1814-20. Zumla, A., Memish, Z. (2014). Middle East respiratory syndrome coronavirus: epidemic potential or a storm in a teacup? Eur Respir J, 1243-8.

Use of Acupuncture for Treatment of Lateral Epicondylitis free essay sample

Lateral epiconylitis is a commonly encountered condition resulting from minor injury to the extensor muscles of the forearm, which originate from lateral epicondyle of humerus. This condition is characterized by pain and tenderness over the lateral epicondyle of humerus. Pain is typically present upon the resisted dorsiflexion of the wrist, middle finger or both (Buchbinder, Green Struijs, 2007). Lateral epiconylitis is known by many analogous terms like tennis elbow (TE), rowing elbow, tendonitis of the common extensor origin, peritendonitis of the elbow etc. In the United Kingdom, the incidence of tennis elbow in general practice has been estimated to be about four to seven per 1,000 persons a year (Buchbinder et al). Though TE is a self-resolving condition its symptoms can persist for as long as 18-24 months. Pain of tennis elbow can interfere with normal day to day functioning like carrying objects, lifting and gripping things etc. Though pain of TE can be initially cured with various conservative treatment modalities and rest, it can frequently recur after resumption of activity. We will write a custom essay sample on Use of Acupuncture for Treatment of Lateral Epicondylitis or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Thus TE can cause significant amount of chronic pain and disability, which can lead to considerable morbidity and financial cost (Buchinder et al, 2007). Thus there is a need for an efficient treatment modality for TE. Till date, physicians and physiotherapists are uncertain about the exact etiology and best management option for patients with TE. There are several conventional therapies which are being used for treatment of TE. These therapies are believed to relieve pain, promote tissue healing and improve joint mechanics. These conventional therapies include anti-inflammatory medicines [NSAIDS (non-steroidal anti-inflammatory drugs) and corticosteroids], physiotherapy interventions (such as stretching and strengthening exercises), cast immobilization, ultrasound therapy, using ice packs, neural stretches, deep friction massages, surgery etc (Trinh, Philips, Ho Damsma, 2004). Various non conventional therapeutic modalities like acupuncture, pulsed electromagnetic field therapy, transcutaneous electric nerve stimulation etc have also been used for treatment of TE. In 1992, Labelle et al attempted to perform a quantitative meta-analysis in order to evaluate the therapeutic effectiveness of above mentioned treatment modalities (both conventional and non-conventional) for patients suffering from TE. They considered the results of 18 clinical trials conducted in the period from 1966 to 1990. From their analysis they concluded that the various randomized and controlled trials, which they had analyzed, were of poor quality and did not provide sufficient scientific evidence to support or oppose the therapeutic benefit of any of these conventional or non-conventional treatment modalities. Labelle et al (1992) did find some weak evidence supporting the beneficial effect of ultrasound therapy in comparison to that of placebo therapy in treatment of patients with TE. More recently, a systematic review of the literature, comprising of randomized controlled trials evaluating the effectiveness of various treatment options for TE was carried out by Assendelft, Green, Buchbinder, Struijs, Smidt, (2003). They have suggested significant beneficial effect of NSAIDS (both topical and oral) in comparison to placebo in the providing short term relief from pain in patients with TE. However they found little evidence regarding the beneficial effect of NSAIDS (both topical and oral) in providing long term pain relief. While the use of topical NSAIDS was not found to be associated with significant side effects, use of oral NSAIDS, typically aspirin was associated with significant side effects like gastro-intestinal bleeding etc. This review found limited evidence regarding the beneficial effects of steroid injections in comparison to placebo, local anaesthetic agents, elbow strapping or physiotherapy. Assendelft et al also found insufficient evidence to support long term or short term beneficial effect of treatment modalities like acupuncture, physiotherapy exercises, orthoses (elbow strapping), extra corporeal shock wave therapy and surgery. They have recommended long term use of oral and topical NSAIDS and physical therapies (elbow strapping, physiotherapy, etc and avoidance of provoking activities as the first line of treatment, especially in the early stages of the disease.   They have also suggested the use of corticosteroid injections as second line therapy for providing relief from pain. However the pain relief provided by corticosteroids is usually temporary in nature with the pain recurring again after a few months. Thus they have suggested that the patients receiving such therapy should be counselled about not subjecting the extensor muscles to increased activity during the pain-free period resulting from use of corticosteroid injections. On the other hand, Bisset, Paungmali, Vicenzino, Beller,   Herbert, (2005) from their systematic review of literature, comprising of studies evaluating   the effectiveness of   various physical interventions (non pharmaceutical or   non-surgical therapeutic modalities) for treatment of TE have shown short term benefit   with the use of physical interventions like ultrasound therapy, ionisation, and acupuncture. However no evidence of long term benefit due to these therapeutic modalities was observed in this review; benefit due to these interventions was usually seen to last between two to eight weeks. Bisset et al observed insufficient evidence regarding the beneficial effect of manual therapy (involving manipulation of elbow or cervical spine), use of elbow strapping and physiotherapy exercises in the management of TE. They also observed the presence of sufficient evidence that disapproved the beneficial effect of extracorporeal shockwave therapy and laser therapy in the treatment of TE (both in short term and long term). However they have indicated the requirement of larger studies in future in order to confirm this finding. Since no clinical study till date has been able to demonstrate definite clinical efficacy of any conventional therapeutic modality in treatment of TE, there has been increasing trend towards the use of non-pharmacological treatment modalities, especially acupuncture, since last two decades, for alleviation of chronic pain due to TE. One major advantage of using acupuncture for treating   pain of TE over the conventional anti-inflammatory drugs like NSAIDS (oral or topical), corticosteroids etc is that it is free from the numerous deleterious   side effects commonly associated with the use of these drugs. Also the evidence supporting the use of these conventional pharmacological interventions is no better than that supporting acupuncture [National Institute of Health (NIH), 1998]. Despite the growing popularity of acupuncture in treatment of pain related to lateral epicondylitis, presently, there is little evidence which confirms the efficacy of acupuncture in treatment of tennis elbow. The studies conducted until now have produced conflicting results. Bisset et al (2005), in their systematic review of literature considered four studies evaluating the therapeutic effect of acupuncture in treatment of TE. Three studies out of these four compared acupuncture with placebo whereas one study compared acupuncture with ultrasound. The overall evidence considered in this review supports short term beneficial therapeutic effect of acupuncture over placebo in patients with TE. Two studies, (Fink, Wolkenstein, Karst, Gehrke, 2002; Molsberger Hille, 1994) which compared acupuncture with placebo are described below in details. Fink et al (2002) conducted a study to evaluate the clinical efficacy of acupuncture in   treatment of TE. They also tried to compare the therapeutic effects produced by stimulating selected acupuncture points (as defined by traditional Chinese acupuncture) in contrast to those achieved through stimulation at non-specific points (these puncture points were at least 5 cm away from the traditional Chinese acupuncture points). The results of this study indicated that use of acupuncture with correct location and stimulation, in accordance to the recommendations of tradition Chinese acupuncture helped in significantly alleviating the pain, reducing disability of arms, shoulders and hands (measured through DASH questionnaire) and improving the strength of the extensor muscles in the patients suffering from TE. However these therapeutic effects (pain relief and muscle strength) of acupuncture were less evident in long term. In this study, at the time of follow-up after two months, though the overall functioning of the arm was observed to be better in the treatment group as compared to the control group, the differences in pain intensity and muscle strength were no longer found to be significant. The main aim of the study by Molsberger Hille (1994) was to find out whether acupuncture showed an intrinsic analgesic effect even after only one treatment session in comparison to that of placebo treatment for TE pain. In one single session of acupuncture treatment, patients in the treatment group were treated at a non-segmental distal point on the fibulo-tibial joint of the homolateral leg. The painful area of the elbow itself was not needled. The depth of insertion was 2 cm and during the procedure of needling, the patient was asked to move the painful arm. Patients were treated for a total of 5 min. Overall reduction in the pain score was 55.8% in the treatment group and 15% in the placebo group. After one treatment session, 79.2% (19 patients out of 24) patients in the treatment group reported pain relief of at least 50%, whereas in the placebo group only 25% patients (6 patients out of 24) reported pain relief. The average duration of analgesia after one treatment was 20.2 h in the treatment group whereas that after placebo was 1.4 h. All these results show that acupuncture has a statistically significant intrinsic analgesic effect in the clinical treatment of TE pain, which exceeds that of placebo treatment.   Since this study dealt with short term analgesic effects of acupuncture, further studies need to be carried out in future in order to evaluate the long-term therapeutic value of acupuncture for treatment chronic tennis elbow. Davidson et al (2001, cited in Bisset et al, 2005) conducted a study to compare the   therapeutic effect of acupuncture with that of ultrasound treatment in patients suffering from TE. Though significant improvement in two outcome measures i.e. pain reduction and disability prevention were observed in both the groups, no statistically significant differences in terms of these outcome measures were observed between the two groups. Thus this study indicates that there is no difference in therapeutic benefit between ultrasound and acupuncture in patients with TE. However it is difficult to reach to any definite conclusion from the results of a single study. More studies are required in future in order to arrive at a definite conclusion. In a publication by the NIH in 1998, it was determined that the results of various studies conducted till date has been promising enough to support the use of acupuncture as an adjunct treatment or an alternative to classical conventional therapeutic modalities for patients with TE. Trinh, et al (2004) conducted a systematic review of literature regarding use of acupuncture in treatment of TE, using the best evidence synthesis approach (BESA), which aimed at qualitative analysis of clinically homogeneous studies. The results of this review strongly suggested that acupuncture was an effective therapeutic modality for attaining short-term pain relief in patients with TE. Though there was a great deal of clinical heterogeneity between various studies considered in this review, five studies out of six studies considered in this review indicated that acupuncture treatment was more effective compared to placebo treatment. The studies conducted till date have failed to provide us with definite results. This can   be attributed to a variety of factors like: flaws in study design, heterogeneous treatment protocols, small sample size, inherent difficulty in the use of appropriate controls etc (NIH publication, 1998). Selection of method for performing the procedure in control group for these studies poses to be a difficult problem. Method of performing the   procedure in control group is important because the insertion of placebo needles itself results in inherent analgesic effect due to release of local ÃŽ ²-endorphins (opioid like substances), which can influence the outcome of the study too (NIH publication, 1998). Future research is recommended to resolve the issues discussed above. Thus there is a need for large scale, well-designed, multicentric, randomized control trials in future that will use standardized treatment protocol and appropriate methods for performing the procedure in controls. It is evident from the above discussion that various studies which aimed at assessing the   efficacy of acupuncture in treatment of TE had employed different processes for performing acupuncture, in terms of location of puncture points, depth of insertion of needles, the number of needles used, duration of treatment etc. In order to arrive at a definite conclusion regarding the efficacy of acupuncture in treatment of patients with TE and in order to maximize the chances for a successful treatment with acupuncture, there is a need for a uniform, accurate and complete description of the most effective method to be used for performing acupuncture in patients with TE. With this in mind, Webster-Harrison, White Rae (2002) conducted a study in order to develop a standardized treatment protocol for acupuncture therapy in patients with TE. They adopted a modified Delphi’s consensus technique to combine the opinions of fourteen British acupuncture experts into a standardized treatment protocol. This protocol contained eight items pertaining to the treatment of TE using acupuncture and has been described in table 1. The various items considered in this protocol were: selection of acupuncture points; length and diameter of needles used; depth of insertion; duration of treatment; interval between successive treatments; whether the needle should be stimulated or not; the type of response to be achieved upon stimulation and number of treatment cycles needed. Use of this protocol in randomized multicentric trials conducted in future is likely to give accurate results (Webster-Harrison et al). Conclusion From the discussion in this paper it becomes apparent that till date no study in published   literature has been able to demonstrate long term beneficial effects of any pharmacological, surgical or physical therapy in comparison to that of a placebo therapy for treatment of patients with TE. Among various non-pharmacological therapeutic options, acupuncture presents an effective and safe adjunct treatment or an alternative to classical conventional therapeutic modalities, especially in cases where these conventional therapeutic modalities had previously failed (NIH, 1998). Presently, the optimal treatment option for patients with tennis elbow in clinical care largely remains unclear. Acupuncture appears to be a lucrative treatment option for both clinicians and patients. However, the therapeutic benefits provided by use of acupuncture are not supported by sufficient evidence, at present. There is a need for well designed, high quality research studies, especially randomized control trials in future, in order to help in establishing the appropriate place for acupuncture in treatment of patients with TE in modern medical practice. References Assendelft, W., Green, S., Buchbinder, R., Struijs, P., Smidt, N. (2003). Extracts from concise   clinical evidence: Tennis elbow. British Medical Journal, 327, 329-340. Bisset, L., Paungmali, A., Vicenzino, B., Belle, E., Herbert, R.D. (2005). A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine, 39(7), 411 422. Buchinder, R., Green, S., Struijs, P. (2007). Tennis elbow. American Family Physician, 75 (5),   701-702. Retrieved on 30 June 2007 from http://www.aafp.org/afp/20070301/bmj.html Fink, M., Wolkenstein, E., Karst, M., Gehrke, A. (2002). Acupuncture in chronic   epicondylitis: A randomized controlled trial. Rheumatology, 41(2), 205 209. Labelle, H., Guibert, R, Joncas, J., Newman, N., Fallaha, M., Rivard, C. (1992). Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow: An attempted meta-analysis. Journal of Bone and Joint Surgery, 74, 646–51. Molsberger, A., Hille, E. (1994). The analgesic effect of acupuncture in chronic tennis elbow   pain.   British Journal of Rheumatology, 33(12), 1162-1165 National Institute of Health (1998). NIH consensus conference: Acupuncture. Journal of   American Medical Association, 280, 1518–24. Trinh, K.V., Philips, S.D., Ho, E., Damsma, K. (2004). Acupuncture for alleviation of lateral   epicondyle pain: A systematic review.   Rheumatology, 43, 1085–1090. Webster-Harrison, P., White, A., Rae, J. (2002).Acupuncture for tennis elbow: An e-mail   consensus study to define a standardised treatment in a GP’s surgery. Acupuncture in Medicine, 20(4), 181-5.

10 Analysis Essay Topics on the Archeological Record

10 Analysis Essay Topics on the Archeological Record While the field of archaeology can sometimes feel bone dry and difficult to write about, you’d be surprised how many interesting things there are to say about the archaeological record. With a little help on which facts to include in your essay writing, you’ll be inspired in no time. In this first guide, we include ten facts on the archaeological record that could be incorporated into an analysis essay, as well as the sources from which these facts are drawn. An essay is only as strong as the facts that it incorporates, so by using this guide you’ll be well on your way to an effective analysis essay. Our second guide outlines 20 topics for an analysis essay on the archaeological record, giving you ideas for how to weave together the facts included below. We also provide a sample essay on the archaeological record in order for you to see a model of how these different topics could be organized into a full analysis essay. Our third and final guide provides a set of instructions and tips for creating an analysis essay on the archaeological record. With help on the actual academic structure of your analysis essay, producing an outline and a full-length essay will come much more easily. So let’s get started! Here are ten verified facts on the archaeological record. The archaeological record includes anything that people have created or modified. This record is used in order to study past cultures and recreate to the best of our ability the lives that people lived in those past cultures and the conditions in which they lived those lives. The knowledge gained from studying the archaeological record gives us the opportunity to appreciate, preserve, and collectively share our common human heritage. The archaeological record, generally speaking, consists of the artifacts, residues, and other general remains of past cultures that have been discovered by archaeologists. More specifically, as is noted by famed archaeology professor Brian Fagan,2 the archaeological record often consists of those things that have been discarded or otherwise abandoned: garbage, scraps, litter, and anything that has been worn out, broken down, or left. Those things that were prized and used heavily often leave no remains. Archaeology attempts to discover past human culture. This refers to the characteristics specific to a particular civilization at a particular time, including the behaviors, beliefs, norms, and living style of that specific social group. The archaeological record cannot discover this directly, and instead represents what is called material culture.1 The material culture of a particular people group, in the absence of written language, is the best approximation we have of the culture of past human societies. As described in a 2013 book by professor Gavin Lucas called Understanding the Archaeological Record,3 there is currently a theoretical divide on how we should consider the truthfulness of the archaeological record. On one side sit the so-called â€Å"naà ¯ve empiricists,† who claim that the archaeological record is constituted purely by those things that have remained from past cultures and is truth given to archaeologists to discover. On the other side sit the â€Å"social constructivists,† who claim that that the archaeological record is a construction that archaeologists have created that may not necessarily represent the truth. As mentioned above, the archaeological record is generally defined as the historical legacy of those material things that people have acted upon. However, as argued in an article by Michael Water and David Kuehn,4 the archaeological record is also shaped by the same forces that act upon the landscape itself. Processes like erosion, severe weather, plate tectonics, natural disasters, and many other geological forces are constantly at work on the information preserved in the archaeological record. The archaeological record is always suspect to contamination and vandalism, whether intentional or accidental. According to an article published online,5 in various Middle Eastern countries it is becoming common practice to loot historically relevant sites and sell those items that are found for profit. Professional looters in the Americas are often referred to as â€Å"pot hunters.† Vandals who take pleasure in destroying valuable things are also in part responsible for the destruction of parts of the archaeological record. As described above, archaeology is best described as the study of the archaeological record. Therefore, any occupation dedicated to understanding the archaeological record falls under the professional heading of â€Å"archaeology.† However, in a quasi-experimental study published by archaeologist Ryan Sneiderman,6 it was demonstrated that a large percentage of people do not understand what archaeologists do, associating their work with fictional characters such as Indiana Jones. Addressing the idea that professional archaeologists do not live the life that characters like Indiana Jones portray in the movies, researchers Amy Ollendorf and Ian Burrow published a review of demographic information on professional archaeologists who joined the Register of Professional Archaeologists.7 Their results demonstrated that Registered Professional Archaeologists granted licensure from the years 2010-2012 included individuals from over 60 different fields of study, and were employed in a variety of different professions falling under the broad categories of private, academic, and government cultural resource management. Given the fragility of the archaeological record described above, archaeologists actively work towards ensuring the safety and preservation of sites that hold parts of the archaeological record. In a 2000 article, William Lipe,8 an anthropologist at Washington State University, argued that the conservation of major archaeological sites is necessary to prevent the illegal excavation and misappropriation of antiquities. Lipe argued that laws and governing bodies should be put in place to balance the economic interests that incentivize the destruction of sites central to the archaeological record. The artifacts and materials that represent the archaeological record differ widely on their age, location, size, and state of preservation. Different branches of archaeology are necessary for dealing with different parts of the archaeological record. Each branch may utilize different research techniques, may take interest in different time periods, and may represent different groups of scholars and archaeology professionals. These branches include prehistoric archaeologists, historical archaeologists, industrial archaeologists, ethno archaeologists, environmental archaeologists, experimental archaeologists, underwater archaeologists, and other branches defined by a particular time period.1 We hope these facts help you nail your assignment. Make sure to also check our guide on how to write an analysis essay on the archaeological record. References: Education Department, AIA (n.d.). Archaeology 101. Retrieved October 30, 2016, from https://www.archaeological.org/pdfs/education/Arch101.2.pdf Fagan, B. M. (1994).  Quest for the Past: Great Discoveries in Archaeology. Waveland Press Inc. Lucas, Gavin. (2012). Understanding the Archaelogical Record. Cambridge University Press. Waters, M. R., Kuehn, D. D. (1996). The Geoarchaeology of Place: The Effect of Geological Processes on the Preservation and Interpretation of the Archaeological Record.  American Antiquity, 483-497. Ojibwa, B. (2015, January 11). The Archaeological Record. Retrieved October 31, 2016, from dailykos.com/story/2015/11/1/1443070/-The-Archaeological-Record Seidemann, R. M. (2013). Maybe Indiana Jones Isn’t So Bad After All.  SAA Archaeological Record, 23. Ollendorf, A. L., Burrow, I. C. (2013). The Register of Professional Archaologists.  SAA Archaeological record, 40. Lipe, William D. (2000). Conserving the In Situ Archaeological Record. Conservation: The Getty Conservation Institute Newsletter 15(1):17-20.

Preparing Students for the Testing Season

Preparing Students for the Testing Season Spring  is traditionally the  season  of beginnings, and for middle and high school students, spring is often the beginning of the testing season. There are district tests, state tests, and national tests for students in grades 7-12 that begin in March and continue through the end of the school year. Many of these tests are mandated by legislation.   In a typical public school, a student will take  at least one  standardized test  annually. Those high school students who enroll in college credit courses  may take even more tests. Each of these standardized tests is designed to take a minimum of 3.5 hours to complete. Adding up this time over the course of  the six years between grades 7-12, the average student participates in standardized testing for 21 hours or  the  equivalent of  three full  school days. Educators can first provide the information that helps students better understand the purpose of a specific test. Is the test going to measure their individual growth or is the test going to measure their performance against others?   Two Kinds of Standardized Testing for Grades 7-12 The  standardized tests  that are used in grades 7-12 are either  designed as norm-referenced or as criterion-referenced tests. Each test is designed for a different measure. A norm-referenced test is designed to compare and rank students (similar in age or grade) in relation to one another: Norm-referenced tests report whether test takers performed better or worse than a hypothetical average student Norm-referenced tests usually are simple to administer and easy to score because they are usually designed as multiple-choice tests.    The criterion-referenced  tests are designed to measure student performance against an expectation: Criterion-referenced  tests and  assessments  are designed to measure student performance against a fixed set of predetermined criteria or  learning standards Learning standards are descriptions by grade level of what students are expected to know and be able to do.  The criterion-referenced tests used to measure learning progress can also measure gaps in student learning.   Preparing Students for the Structure of Any Test Teachers can help prepare students for both  kinds standardized tests, both norm-referenced  tests and criterion-referenced  tests. Educators can explain to students the purpose of both criterion referenced and  the norm-referenced test so students will have a better understanding when they read the results. Most importantly, they can expose students to the pace of the exam, to the format of the exam and to the language of the exam. There are practice passages  in texts and online from different tests that will allow students to become more familiar with  the format of the test. To prepare students for the pace of the exam, teachers can offer some practice testing under conditions that mimic the actual test. There are released tests or materials that mimic the test that students should be encouraged to take independently. A timed practice text is particularly helpful is giving students the experience so they will know how fast they have to move to answer all the questions. Multiple practice sessions for timed essay writing should be offered if there is an essay section, for example, like the AP exams. Teachers have to coach students to determine a pace that works for them and recognize given how much â€Å"average† time they will need to read and answer an  open-ended question. Students might practice how to survey the whole test at the beginning and then look at the number of questions, point value, and difficulty of each section. This practice will help them to budget their time. Exposure to the format of the exam will also help student distinguish the amount of time that might be needed in reading multiple choice  questions. For example, one standardized test section requires students answer   75 questions in 45 minutes. That means students have an average of 36 seconds per question. Practice can help students adjust to this speed. In addition, understanding the format can help students negotiate the layout of a test, especially if the standardized test has moved to an online platform. Online testing means a student must be proficient in keyboarding, and also know which keyboarding feature is available for use. For example, the computer-adaptive tests, like the SBAC, may not allow students to return to a section with an unanswered question.   Multiple Choice Preparation Educators can also help students practice with how tests are administered. While some of these remain pen and paper tests, other tests have moved to online testing platforms. A part of test preparation, educators may offer students  the following multiple choice question strategies: If any part of the answer is not true, then the answer is incorrect.  When there are identical responses, then neither is correct.Consider no change or none of the above as a valid answer choice.Students should eliminate and cross off those distracting answers that are absurd  or obviously incorrect.Recognize transition words that  describe relationships between ideas in choosing a response.  The stem or start of the question should agree grammatically   (same tense) with the correct answer, so students should quietly read the question aloud to test each possible response.Correct answers may offer relative qualifiers such as sometimes or often, while incorrect answers are generally  written in absolute language and do not allow for exceptions. Before taking any tests, students should know if the test gives a penalty  for incorrect responses; if there is no penalty, students should be advised to guess if they dont know the answer.    If there is a difference in the point value of a question, students should plan on how they will  spend time on the more weighted sections of the test. They should also know how to split their time between multiple choice and essay answers if that is not already separated by section in the test. Essay or Open-Ended Response Preparation Another part of test preparation is  teaching students to prepare for essays or open-ended responses. Students to write directly on paper tests, take notes or use the highlighting feature on computer tests in order to identify sections that can be used for evidence in essay responses: Follow the directions by looking carefully at keywords: Answer A  or  B vs.  A  and  B.Use facts in different ways: to compare/ contrast, in  sequence or to provide a description.Organize facts  based on headings in informational texts.Use transitions with enough context in a sentence or paragraph to make the relationships between facts clear.Suggest that  students answer easiest questions first.Suggest students write on only one side of the page.Encourage students to leave a large space at the beginning of a response, or to leave a page  in between,  in the event a student ends up with a different thesis or position or would like to add or to change details later if time permits.   When time is limited, students should draft an outline by listing key points and the order they plan to answer them.   While this would not count as a complete essay, some credit for evidence and organization may be credited.   Which Tests Are Which? Tests are often better known by their acronyms than why they are used or what they are testing. To get balanced data  from their assessments, some states may have students take  norm-referenced tests as well as  criterion-referenced tests in different grade levels. The most familiar  norm-referenced tests  are those designed to rank students  on a  bell curve The  NAEP  (The National Assessment of Educational Progress)  reports  statistical information about student performance and factors related to educational performance for the nation and for specific demographic groups in the population (e.g., race/ethnicity, gender);The SAT  (Scholastic Aptitude Test and/or  Scholastic Assessment Test);  Scores on the SAT range from 400 to 1600, combining test results from two 800-point sections: mathematics, and critical reading and writing.  The following states  have opted to use the SAT as a high school  exit exam:  Colorado,  Connecticut, Delaware, District of Columbia*, Idaho* (or ACT), Illinois, Maine*, Michigan, New Hampshire, New York, Rhode Island*. (*optional)  PSAT/NMSQT  a precursor to the SAT.  The test is composed of four sections: two Math Sections, Critical Reading, and Writing Skills used to determine eligibility and qualification for the  National Merit Scholarship Program.  Students in grades 8-1 0 are the target audience for the PSAT.  The  ACT  (American College Test) is four  content area tests  scored individually on a scale of 1–36, with the composite score as the whole number average. The ACT does have elements of  a criterion-referenced in that it also compares how a student performs compared to ACT College Readiness Standards which are regularly reviewed.  The following states  have opted to use the  ACT  as a high school  exit exam:   Colorado,  Kentucky,  Louisiana,  Mississippi,  Tennessee,  Utah. ACT Aspire  tests map learner progress from elementary grades through high school on a vertical scale which is anchored to the scoring system of the ACT. Challenges to the tradition of norm-referenced testing came with  the expansion of  criterion-referenced tests in 2009 when tests were designed to measure  the impact of the  Common Core State Standards (CCSS).These  criterion-referenced  tests determine how college and career ready a student is in English Language Arts and in mathematics.   While initially embraced by 48 states, the two testing consortiums have the remaining states committed to using their platforms: The  Partnership for Assessment of Readiness for College and Careers  (PARCC) in the following states  Colorado,  District of Columbia,  Illinois,  Louisiana,  Maryland,  Massachusetts,  New Jersey, New Mexico,  Rhode IslandThe  Smarter Balanced Assessment Consortium  (SBAC)  The states that use this  SBAC computer adaptive testing include:  California,  Connecticut,  Delaware,  Hawaii,  Idaho,  Iowa,  Michigan,  Montana,  Nevada, New Hampshire,  North Carolina,  North Dakota,  Oregon,  South Dakota,  U.S. Virgin Islands,  Vermont,  Washington,  West Virginia The College Board  Advanced Placement (AP)  exams  are also criterion referenced. These exams are created by the College Board as  college-level exams in specific content areas.  A high score (5) on the exam may award college credit. At the conclusion of the spring testing season, the results of all these tests are then analyzed by different stakeholders in order determine student progress, possible curriculum revision, and in some states, teacher evaluation. The analysis of these tests can guide the development of a schools educational plan for the following school year. Spring may be the season for testing in the nations middle and high schools, but preparation for an analysis of these tests are a school year long enterprise.

Argument Paper#1 Essay Example | Topics and Well Written Essays - 750 words

Argument Paper#1 - Essay Example e method through which the government and the policy makers can increase and encourage others to donate organs is by paying donors and their family members for donations either by paying them in hard cash or providing them with benefits that have a monetary value such as tax credit or a better retirement plan. There is a heavy debate amongst policy makers about whether to use monetary incentives to promote organ donation or not. There are several reasons due to which opponents of monetary incentives are against this method, but the proponents have a very solid case to defend the position of using monetary incentives. Selling of organs should be encouraged and should be legalized in order to save important lives, in order to make organs more accessible and to decrease the healthcare cost of the government. Selling of organs should be legalized by the government if it wants to save significant lives that are waiting on the list of receiving organ donation. A huge number of people who are waiting for the donation are those who belong to the youth category of the society. This section of the society is very essential for the better future of the society. Siegel in his article has stated that there are young and healthier individuals who are waiting for a donation (Siegel, 2011). If selling of organs is legalized, it will encourage living people to donate their organs and it will even encourage people to get themselves registered for donating their organs after their death. This in turn will help in saving several young individuals who are healthy and can contribute to the society in a healthy manner. Legalizing sale of the organs will increase the accessibility of the organ donation amongst those who cannot afford to purchase organs. Currently there is a black market of organ donation and in this black market a huge number of organs are being sold at very high prices which are only accessible by those who belong to high income earning groups. At the same time there

Costa Coffee Enters France Essay Example | Topics and Well Written Essays - 1750 words

Costa Coffee Enters France - Essay Example Coffee culture in France is rather old; even prominent historical writers have been known to mention a cafe or two in their accurate descriptions of the French revolution. Therefore, coffee businesses are ubiquitous in France; one can find a coffee shop in almost every street corner in the nation’s capital. Most of them are high-end, chic cafes, with lots of decorated interior designs and room for interaction with one’s acquaintances. These types of shops can mostly be found in places like Saint Germaine as well as the Left Bank, which also has a high concentration of elegant coffee shops. Typically, a French cafe will have both an indoor and outdoor setting with plenty of wooden interior designs and an intimate atmosphere all around. Cakes, pastries or sandwiches may be available but most consumers go into these shops for the coffee; espresso in small cups is their preferred choice while others may choose different versions of the espresso and cream. Most French waiters in these cafes seem ambivalent about meeting consumer needs and may even appear arrogant to foreign nations. Smoking used to be a distinct aspect of coffee culture in France but after its ban, most patrons prefer to smoke in the outdoor section of the cafes. Overall, the ambiance of cafes makes coffee cultures predominantly unique in France; people think of coffee drinking as a ritual to be enjoyed. Waiters care little about turnover rates, so patrons have the freedom to sit in as long as they like while catching up with friends. The cafe is a social meeting place and reflects the unhurried nature of French culture in comparison to other western societies.

Negative impact Essay Example for Free

Negative impact Essay There is a proven link between the growing human population and the sustainability of the environment. In Florida’s case, the state has one of the highest rates of population growth in the U. S. with a rate of more than 25% over a period of 10 years (1990-2000), and the consumption (and over-consumption) of resources by this ever-increasing multitude has resulted in the degradation of the ecosystem’s health. Aside from this, the products of human consumption (such as wastes) and human activities, have contributed to the upset in the biogeochemical cycle, and consequently, the ecosystem’s demise. For example, the collapse of Florida’s coastal ecosystems has been tied by scientists to overfishing. Wetlands too, are disappearing at an alarming rate. People are also encroaching upon the natural habitat of animals, displacing the native animal population. For instance, this has lead to an increasing number of snakes and alligators in residential areas. What do you consider the greatest positive impact that humans have made in the same area? In Florida, water is a scarce and depleting resource. Because of the state’s high rate of population growth, scientists are estimating that water drawn from the largest potable water reservoir, the Florida aquifer, will run out by the year 2025. The problem has escalated to a critical point that in Central Florida, potable water is not allowed to be used in irrigation. In 2002, Department of Environmental Protection has launched a statewide comprehensive Water Conservation Program for the public’s water supply. This program has garnered a lot of support and publicity from various sectors of society including the media, schools, even business establishments, and has resulted in further research in the area of water conservation and resource preservation.

Poetic Tools Describe Life in Walt Whitmans Song of Myself Essay

Poetic Tools Describe Life in Walt Whitman's Song of Myself Walt Whitman is commonly known as the bard of America, a poet who wrote about the common man of the country as had never been done before. He was able to do so because he was a common man, as can be seen in lines such as "This is the city and I am one of the citizens." Within his poetry he often used certain tools of the typical epic tale, borrowed from such tales as The Iliad, and The Odyssey. All of these tools can be seen within the lines of his lengthy poem of fifty-two sections "Song of Myself." The first of these tools include an invocation of the muse, as can be seen in the lines "I loafe and invite my soul," which appears to be an invocation of a muse, or his own soul which may also be his muse. Another tool used is cataloguing, throughout this poem Whitman incorporates many descriptions and images that he lists in a catalogue form. Another typical epic tool is that of beginning en medias res, or in the middle of things. The use of similes, comparisons using like or as are a nother epic tool that is pervasive within Whitmans works. The final tool Whitman uses is the intermingling of high and low, or the common man associating with people of a different class for example when he compares someone to the president " Have you outstript the rest? are you the President?" Whitman also incorporates certain personas into his works when he uses "I" and "me", which do not always refer to him. Lastly, Whitman uses a form of writing called free verse, which exhibits no conscious rhythmic structure, it is unrhymed. It is with this form that Whitman sets out to capture the American vernacular, making his poetry more of a representation of Americas common man. Secti... ...mbryo, saying "My embryo has never been torpid." Using his well-known tool of cataloguing he lists several items such as a "nebula," an "orb," "strata," "vegetables," and "sauroids." All of which are items of the past and add to the theme of eternity. It is with these words and images that Whitman incorporates his life into the great expansive eternity. He shows how he, and everyone else fits into the great timeline, and ultimately how the past can effect ones life in the present. Ultimately Whitman comes to realize just this, that the past has come to make him who he is and he ends the section by saying "All forces have been steadily employed to complete and delight me, Now I stand on this spot with my soul." Works Cited: Whitman, Walt. Song of Myself. The Heath Anthology of American Literature. 3rd ed. Ed, Paul Lauter. Boston,NewYork: Houghton Mifflin, 1998.

The Harlem Renaissance and a New Cultural Identity

A New Cultural Identity By Anus Overstress AkA Awesome, Cool, Brilliant and any other synonyms of these qualities Originally known as the New Negro Movement, the Harlem Renaissance was a period of immense social activity and great innovations among artist and writers. The movement's name is derived from its origin; Harlem New York. At this time Harlem became the Mecca to which scholars, writers, musicians and photographers traveled.African American migration to the northern states played a major role in the initiation of this intellectual movement which harbored and preserved a new black cultural identity in multiple aspects. Prolific writers such as Longboats Hughes influenced many poets. The improvisation of Jazz and its syncopated rhythms was popularized by Jazz legends such as Duke Elongating and Louis Armstrong. The Harlem Renaissance began in the late sass's after World War II. However much of the foundation of this movement was established by earlier generations of African Ame rican educators, students, and intellectuals.In the decades following the Civil War, multiple racial barriers to education were removed and African Americans took advantage of the new educational opportunities in prodigious numbers. Due to the harsh aspects of the Jim Crow laws in the south (which contained approximately 90 percent of the Black population at the time) and the discrimination and mistreatment that followed, African American individuals migrated to the urban northern states to escape the oppressive system of the rural south where they were able to find work.Some of the most prominent works created during this era were in the field of literature. Longboats Hughes was the epitome of prolific writers and a leader of the Harlem Renaissance. He is best known for his pomes which he wrote with the rhythmic pattern of Jazz and blues which influenced many poets. Hughes first book of poetry, The Weary Blues, was published in 1926. The book was very popular and established both h is poetic style and his commitment to black themes and culture. Hughes skillful use of words to portray African American heritage played a major ole during this era.No aspect of the Harlem Renaissance shaped the United States as much as Jazz. Jazz flouted many musical conventions with its syncopated rhythms and improvised instrumental solos. Thousands of city dwellers flocked night after night to see the same performers. Singers such as Bessie Smith and Billie Holiday popularized blues and Jazz vocals. Duke Elongating and Louis Armstrong drew huge audiences as white Americans caught Jazz fever. For the first time white Americans could not look away.The Harlem Renaissance was a major period in American history. The northward migration by African Americans to escape white supremacy in the rural south played a major role in the ignition of this intellectual movement. Its origin Harlem, brought notice to great works that might have otherwise been lost. Writers of this era such as Longbo ats Hughes were extremely influential and Jazz legends Duke Elongating and Louis Armstrong took this form of art characterized by improvisation and syncopation to new levels of innovation.

Pacific Grove

Question 1: Based on the company’s forecasted financial statements, can the company quickly comply with the banks requirements? It depends on what you consider quickly. If the deadline is to only to have a plan ready by June 30th, 2012 then it looks like they can come pretty close without implementing any major changes. Just by following their expected future growth plans they will almost reach the requirements of the bank within 4 years. Using the information provided from their forecasted financials, by 2015 Pacific Grove will reach a 55% ratio of interest/bearing debt to total assets and their equity multiplier will be 2. 7. (See Exhibit 1) Depending on how stringent the bank is this may not be quick enough of a timeline or progressive enough of a plan. If they want these figures lowered to the required levels by 2012 then Pacific Grove must do something more aggressive reduce interest bearing debt levels. The company should explore ways to reduce its need for working capit al financing. They should see if there are ways of improving their supply chain efficiency and forecasting so that they can reduce their inventory levels.They should look to negotiate with suppliers to reduce the rate they are paying for inventory. Pacific Grove should also see if they can extend the length of their accounts payable. Even if they have to pay a slight price premium, if the rate(APR) is less than what the banks are charging them in interest, it could help to both save money and reduce their capital needs. They should also see if they can adjust the credit policy terms with their customers to shorten the number of days before payment.By reducing receivables and increasing payables they should be able to reduce their financing needs from the bank in notes payable and thus lower their interest-bearing debt. It is unlikely that even with changes in working capital structure they will be able to reduce their debt within a year. Raising funds by selling common stock to pay- off some of their interest bearing debt may be necessary in order to quickly comply with the banks requirements. My suggestion however would be to acquire the other company which has better debt structure.When the two companies are financial are combined Pacific Groves ratios will be under those required by the bank. Exhibit 1: 2. Should the new television program be produced and sponsored by Pacific Grove Spice? If yes how the necessary investment should be financed? I would say no. At first glance the new investment looks good. The upside of the investment is that it would increase the company’s sales, profits, and cash flow above their currently expected levels. Despite this upside it also significantly increases the yearly net working capital investment.The additional funds needed to pay for additional working capital means that the project has negative cash flow for both year 0 and year 1. Pacific Grove would really need to borrow or raise a total $2,573,118 to initially start and fund the venture before positive project cash flows start. If we are only looking at the financial implications of investing in the company using the expected IRR and NPV we may be fooled into thinking this new television program would be a great investment. Even if our WACC were 20%, we can expect the NPV of the project to be $1,716,414.When we look at discounted payback, however, we see that at a WACC of 20% the project payback period would be a little over 4 years and even the simple payback period is 3 years (see exhibit 2). This demonstrates that there is significant risk that the project investments may not be paid off, especially if actual performance is worse than expected. The most important issue currently facing the company is to reduce its interesting bearing debt so that it can continue to receive financing from the bank to support operations and growth.Investing in a project with a payback period of 3 years or longer would not be a wise decision as it would initially raise the level of interest bearing debt unless funded through the selling of equity. Although there may be some synergies between the television network and Pacific Grove which could help to promote their brand, it may also take away needed focus from their core business and lead to a poorer performance and erosion of its competitive position in the market.Pacific Grove’s lack of experience and knowledge about producing a television show add to the level of risk of the project. If they were confident that the investment will work the only viable option to raise capital while not increasing debt would be to sell shares in the company. This may not please current shareholders as they would face dilution in both the value of their shares and their percentage of ownership in the company. Exhibit 2: 3. Should the company issue new common stock to the external investment group?No, I don’t think they should issue the stock. If they decide to issue shares they will lose some percentage of their company control. In fact, Peterson and the Founders will go from controlling a total of 32% of the company to only 23. 8% meaning that the investment group would actually have more control of the company than the founders at 25. 6%. (See exhibit3) Although the share price will only drop slightly to $31. 30, the dilution of shares and drop in stock price may displease current shareholders.The market may respond by the further selling off of existing shares dropping the stock price more and further hurting the company’s financial status. Another problem with issuing the common stock is that although it will provide access to capital which they can use to pay off interest bearing debt If the bank requires the company to lowers its debt levels within the next year and no other banks are willing to lend, then issuing the common stock may be seem like the only viable option to quickly meet the bank’s lending requirements.I would argue, however, that acquiring High Country Seasoning company would be a better choice as it will also resolve the debt issues while also providing other synergies and not lowering the stock price of the company. Exhibit 3: 4. Should Pacific Group Spice acquire High Country Seasonings? Yes. Acquiring High Country Seasoning would help to do several things. First because of the company’s better financial debt structure will improve Pacific Spice Groups overall debt structure upon merging.The deal would not require the issuance of debt and would not lower the company’s current stock price. The two companies also operate in the same business line. This should help them to become a stronger player in the market by capturing more market share in the industry. There should be some cost savings because of economies of scales and the ability to leverage both companies’ assets. The only question remaining is whether the purchase price is greater than the estimated value of the company. E xhibit 4: Exhibit 5:

OSH Situation essays

OSH Situation essays The Occupational Safety and Health act of 1994(OSHA) is appropriate and an adequate basis for the improvement of the working environment for all employees in Malaysia. OSHA ensures safety, health and welfare of person at work. The main objectives of this project is to conduct an enquiry among the workforce of the industries, focusing on OSH as a general issue with attention to various industries an identifying any situation related to OSHA and Environmental Quality Act 1974,which does not comply with the regulation outlined in both acts. Nihon Canpack (Malaysia) Sdn. Bhd. situated in Batu Gajah, Perak, is a company which obtained 100 percent trust from NESTLE and produces 8 types of drinks (MILO, NESCAFE REGULAR, NESCAFE DARK COFFEE, NESCAFE MOCHA, NESTEA LEMON, MANGGO AND ORANGE) base on recipe from Nestle. The company also has wastewater treatment plant which costs RM 1 million. It was built according the Environmental Quality Act 1974 to ensure the quality of water before it will be released to the environment. Besides that the water recycling machine is able to recycle half of 350 metric tan of water used everyday. Nihon Canpack (Malaysia) Sdn.Bhd. provide a good OSHA situation at the factory. However, they still need some improvements to enhance their working environment so that the workers will feel more comfortable to do their work. As stated in the company philosophy, the company wants to create a conducive environment for job enrichment. The word conducive means comprises both good qualities of physical and mental aspects in the working environment. These two elements need to be considered by the company to improve OSH situation at the workplace. This company complies with most of the vital requirement in OSHA 1994 and most of the workers believe that their workplace is safe. The only weaknesses are due to inattentiveness of the employer and employee about the safety act that should they take. This inattentiveness...

9 ways on how to turn your hobby into a successful business

9 ways on how to turn your hobby into a successful business Hobbies are something we enjoy doing when we have free time. Whether it’s painting, playing sports, or even gardening, hobbies help us relax while doing something we love. What if there was a way to get paid to do your hobby? Well, there is! Here are 9 ways you can turn your hobby into a profitable business. It’s time to get paid for something you truly love to do.  Source [ Omni Papers ]

Soviet Emphasis on Film Editing Assignment Example | Topics and Well Written Essays - 250 words

Soviet Emphasis on Film Editing - Assignment Example This paper illustrates that the Kuleshov workshop studied three basic functions or cutting methods, which would very well enhance the film quality. The first function of serving a cut would be in the narrative sense of the film. Through this type of cut, the director, as well as the editor, can very well analyze the actions that have been produced from the psychological processes, which happen within an individual. The second function of a cut was with regards to the intellectual responses, which were generated from the characters in the film. This could very well delve into the interpersonal relationships that could be produced, due to the various thought processes. The third kind of cut that was taught in the Kuleshov workshop was, with respect to the emotions that were being produced within a film due to the interactions among the various characters. Hence such responses were purely produced by the emotions deep within the minds of the individuals. In the case of the second type o f cut, that is considered to be purely for an intellectual purpose, was found not only to be serving and challenging the mental thought process but also will sometimes serve the purpose of the narrative cut. As far as Russian films are concerned Eisenstein’s is the greatest master of Montage, which in other words means editing. As per Eisenstein, the essence of the principle of Montage could very well be considered, as the combination of contrast, collision, and conflict. The significance of the basic plot of Battleship Potemkin was that it was a film that was produced in order to depict Russia’s general workers’ revolt. The entire plot revolves around two basic events, one that involved the revolt of the rebellion that took place on the Potemkin that was a battleship. The second event was based on the Odessa reprisals, which occurred between the Cossacks and the Czar’s troops.

China and the Bull-run Stock Market Essay Example | Topics and Well Written Essays - 2250 words

China and the Bull-run Stock Market - Essay Example The paper tells that the entry of Chinese economy into the World Trade Organisation (WTO) in 2001 is, no doubt, a significant event in the history of a world economy. It has given a boost to the pace of reform and opening up. The Sino economy has gathered further momentum. That was the reason that Chinese economy registered a real GDP growth of phenomenal 9.5 percent in 2004. China's status of "world factory" is the result of that impressive growth show. The excellent performance of economy paved a way to massive capital inflows and pushed country's foreign exchange reserves to more than 600 billion dollars in 2004. Where there is much to celebrate for Chinese, all is not well with this elephant economy of the world. If we analyzed then we came to know that China's bond market comprises of two major markets: the inter-bank bond market and the exchange market. Subsequent to further than ten years of expansion, China's bond market has turned out to be a multi-layered one in which the i nter-bank market plays the most important position, complemented by the exchange market. According to the expert analysis, China's soaring stock market is at risk of "a market correction" that could have a knock-on result on its whole banking system, the OECD said yesterday, adding its voice to a litany of bearish warnings on the country's split prices. The hazard has arisen despite enlargement of nearly 11 percent last year and a predictable speeding up in customer expenditure ahead, the Paris-based Organization for financial collaboration and growth said. No doubt, Chinese stocks seesaw in trade but shrugged off the caution from Mr. Greenspan and one more from the market watchdog. The Shanghai compound Index healthier its balance after an early fall of as much as 2 percent, to close down 0.54 percent at 4,151.13 points. Previous, it hit a record intraday high before Mr. Greenspan's comments turn out to be extensively known. Turnover in Shanghai a split was a huge 247.4 billion yua n (16.4 billion), the second-highest numeral to date. Though, neither the government declaration nor Mr. Greenspan's warning had any real collision on an investor's eager to income from the market's bull run. The most investors sight as strange the idea that the Government, which motionless wields enormous pressure over fund flows during administrative steps, would permit a crash. Analysts said that the marketplace might merge gains for a few days before resuming its scale. If the bubble were to pop, it could have a better impact on communal stability than any previous slump in the stock market's 16-year the past. There are now additional than 91m accounts held by individuals at brokers or in joint funds. Estimates for the number of investors differ extensively. At the height of the last marketplace boom, in 2001, there were 60m accounts but maybe fewer than 10m investors. There are surely lots of millions more now.